Instructions.
The following recommended disposition was prepared for U.S.
District Judge Susan W. Wright. A party to this dispute may
file written objections to this recommendation. An objection
must be specific and state the factual and/or legal basis for
the objection. An objection to a factual finding must
identify the finding and the evidence supporting the
objection. Objections must be filed with the clerk of the
court no later than 14 days from the date of this
recommendation.[1] The objecting party must serve the
opposing party with a copy of an objection. Failing to object
within 14 days waives the right to appeal questions of
fact.[2] If no objections are filed, Judge
Wright may adopt the recommended disposition without
independently reviewing all of the record evidence.

Background.
Delena A. Spears seeks judicial review of the denial of her
application for social security disability
benefits.[3] Spears worked at a bait shop when she
was diagnosed with hepatitis C.[4] She quit her job and
applied for disability benefits.[5] She based disability on
hepatitis C, hypothyroidism, cirrhosis of the liver, and
depression.[6]

The
Commissioner's decision. The ALJ identified adjustment
disorder, polysubstance abuse by history, hepatitis C,
cirrhosis of the liver, and migraines as severe
impairments.[7] The ALJ determined Spears can do
unskilled light work.[8] The ALJ consulted a vocational expert,
determined jobs existed that Spears could do, and denied the
application.[9]

After
the Appeals Council denied review, [10] the ALJ's
decision became the Commissioner's final decision for the
purpose of judicial review.[11] Spears filed this case
to challenge the decision.[12] In reviewing the
decision, the court must determine whether substantial
evidence supports the decision and whether the ALJ made a
legal error.[13] This recommendation explains why the
court should affirm the decision.

Spears's
allegations. Spears challenges three aspects of the decision:
(1) development of the record, (2) the psychiatric review
technique, and (3) the determination that she can do
unskilled light work. She contends substantial evidence does
not support the decision.[14]

Applicable
legal principles. For substantial evidence to exist, a
reasonable mind must accept the evidence as adequate to show
Spears can do light work.[15] "Light work
involves lifting no more than 20 pounds at a time with
frequent lifting or carrying of objects weighing up to 10
pounds."[16] The ALJ required unskilled work;
that is, work involving (1) simple, routine, repetitive
tasks; (2) incidental interpersonal contact; and (3) simple,
direct, concrete supervision.[17] A reasonable mind will
accept the evidence as adequate to support the decision for
the following reasons:

1.
Medical evidence established no disabling physical symptoms.
The claimant must prove disabling symptoms with medical
evidence; subjective allegations are not
enough.[18] On January 3, 2013, lab work
confirmed the presence of hepatitis C[19] - an inflammatory
disease of the liver.

After
the lab work, a gastroenterologist examined Spears. The
gastroenterologist diagnosed hepatitis C, cirrhosis of the
liver, and hypertension; he attributed cirrhosis to alcohol
use and hypertension to cirrhosis.[20] At that time,
Spears's abdomen was distended, but she had no ascites in
the abdomen.[21] This finding is significant because
ascites signal severe disease.[22] At the hearing, Spears
testified about numerous disabling symptoms, but treatment
records contradicted the testimony. According to agency
medical experts, the medical evidence established no severe
impairment.[23]

After
the hearing, Spears began drug therapy for hepatitis C.
Treatment notes showed she tolerated treatment[24] until she
over-dosed on an anti-depressant. Spears was admitted to a
hospital mental health unit and treated for elevated liver
enzymes.[25] The record doesn't detail the
treatment, but later treatment records showed Spears had a
good result.[26] Plans were made to resume drug
therapy. No evidence suggests Spears lacked the capacity to
do light work.

2. The
ALJ accounted for mental impairment. On judicial review,
Spears relies, in significant part, on mental impairment.
Because the ALJ rejected a therapist's medical statement,
she contends the ALJ should have done more to develop the
record.

The ALJ
has a duty to fairly and fully develop the record as to the
matters at issue.[27] Spears's claim placed depression
at issue. The ALJ responded by ordering a mental diagnostic
exam. The mental examiner was unable to assess Spears's
mental state due to exaggerated dramatic behavior; the
examiner characterized exam results as invalid.[28]

Spears
contends her mental state later deteriorated. She relies on a
one-time diagnosis of hepatic encephalopathy - a decline in
brain function from severe liver disease - but that diagnosis
was a tertiary diagnosis by someone who is not an acceptable
medical source for the purpose of establishing a medically
determinable impairment.[29] The medical statement flowed from
a referral for marijuana addiction.[30] Treatment for
hepatitis C was delayed because Spears used marijuana. Spears
may have suffered some depression and anxiety related to
hepatitis C, but her primary diagnosis was cannabis
addiction.[31]

Spears
insists her mental state deteriorated further, manifesting in
a suicide attempt, but the record documented hospitalization
"in the Psychiatric unit for some depression and altered
mentation, "[32] not a suicide attempt. Spears's
report of a 14-day hospitalization is unsubstantiated. Even
if Spears's mental state deteriorated due to hepatitis C
treatment, [33] she reported feeling much better a
few days later.[34]

Spears's
argument about a flawed psychiatric review technique lacks
support. The ALJ relied on mental health
experts[35] and treatment records. Her complaint
is based on disagreement, rather than flawed process. Spears
contends the ALJ should have ordered a second mental exam,
but the record provided sufficient evidence to determine
whether Spears was disabled.[36]

Spears
likely had some mental impairment. She had minimum
education.[37] The mental diagnostic examiner
diagnosed adjustment disorder and suspected borderline
intellectual functioning;[38] the therapist who
prepared the medical statement characterized Spears as
average functioning.[39] She took anti-depressant medication.
To the extent Spears was mentally impaired, the ALJ accounted
for mental impairment by requiring work involving (1) simple,
routine, repetitive tasks; (2) incidental interpersonal
contact; and (3) simple, direct, concrete supervision.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;3.
Vocational evidence supports the decision. A vocational
expert classified past work as a work bench operator as
semi-skilled medium work, a warehouse worker as unskilled
medium work, and a kitchen supervisor as skilled medium
work.[40] Because this ...

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